FDG PET/CT for tumoral and systemic immune response monitoring of advanced melanoma during first-line combination ipilim
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ORIGINAL ARTICLE
FDG PET/CT for tumoral and systemic immune response monitoring of advanced melanoma during first-line combination ipilimumab and nivolumab treatment Amir Iravani 1,2 & Medhat M. Osman 3 & Alison M. Weppler 4 & Roslyn Wallace 4 & Anna Galligan 4 & Arian Lasocki 1,2 & Morgan O. Hunter 5 & Tim Akhurst 1,2 & Michael S. Hofman 1,2 & Peter K. H. Lau 2 & Damien Kee 2,4 & George Au-Yeung 2,4 & Shahneen Sandhu 2,4 & Rodney J. Hicks 1,2 Received: 26 January 2020 / Accepted: 6 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose We aimed to investigate the role of FDG-PET/CT in monitoring of response and immune-related adverse events (irAEs) following first-line combination-immune checkpoint inhibitor (combination-ICI) therapy for advanced melanoma. Methods We retrospectively reviewed outcomes in patients who had (1) first-line nivolumab plus ipilimumab; (2) pre- and posttreatment FDG-PET/CT scans (pre-FDG-PET/CT and post-FDG-PET/CT) within 2 and 4 months of starting ICI, respectively; and (3) at least one lesion assessable by PET response criteria in solid tumors (PERCIST). Extracranial response was monitored by 3 monthly FDG-PET/CT. Whole-body metabolic tumor volume (wbMTV) was measured pre- and post-treatment and correlated with outcome. FDG-PET/CT manifestations of irAE were defined as new increased non-tumoral uptake on postFDG-PET/CT and were correlated with clinical presentation. Results Thirty-one consecutive patients, median age 60 years (range, 30–78), were identified from 2016 to 2018. The median number of combination-ICI cycles to the first post-FDG-PET/CT response assessment was 3 (interquartile range (IQR), 2–4). The best-overall responses were complete metabolic response (CMR) in 25 (80%), partial metabolic response (PMR) in 3 (10%), and progressive metabolic disease (PMD) in 3 (10%) patients. Patients with PMD had significantly higher pre-treatment wbMTV (p = 0.009). At a median follow-up of 21.5 months, 26 (84%) patients were alive with median progression-free and overall survival not reached. Secondary progression occurred in 9/31 (29%) patients at a median of 8.2 months (IQR, 6.9–15.5), of those majority (78%) was detected by FDG-PET/CT. Of 36 findings on post-FDG-PET/CT suggestive of irAE, 29 (80%) had clinical confirmation. In 3 (7%), the FDG-PET/CT findings preceded clinical presentation. The most common FDG-PET/CT detectable irAEs were endocrinopathies (36%) and enterocolitis (35%). Conclusion FDG-PET/CT response evaluation predicts the long-term outcome of patients treated with first-line combinationICIs. Long-term treatment response monitoring for detection of extracranial secondary progression is feasible by FDG-PET/CT. Beyond response assessment, FDG-PET/CT frequently detects clinically relevant irAEs, which may involve multiple systems contemporaneously or at various time-points and may precede clinical diagnosis.
This article is part of the Topical Collection on Oncology - General Electronic supplementary material The online version of this a
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